Abstract 12440: Acetylcholine-Provoked Myocardial Lactate Production is Frequently Observed in Non-smoking Female Patients With Multivessel Coronary Spasm
Acetylcholine (ACh)-provocation test is widely used to diagnose coronary vasospastic angina (VSA). Myocardial lactate production (MLP) ratio is a supporting diagnostic marker useful in the evaluation of myocardial ischemia in ACh-provocation test. However, clinical characteristics, predictive factors, and long-term prognosis of ACh-positive patients according to MLP are not fully investigated. We enrolled 1279 consecutive patients who underwent the MLP measurement during ACh-provocation test in left coronary artery. Coronary spasm was defined as total or subtotal obstruction (focal spasm), or severe diffuse vasoconstriction (diffuse spasm) of epicardial coronary arteries. 673 ACh-positive patients were divided into two groups according to MLP [378 MLP-positive and 295 MLP-negative patients]. Female gender, non-current smoking, serum HDL cholesterol level, diffuse spasm, and multivessel spasm were significantly higher in the ACh-positive group with MLP than those without (57% vs. 32%, p≤0.001, 60% vs. 35%, p≤0.001, 56 mg/dL vs. 51 mg/dL, p=0.046, 47% vs. 37%, p=0.01, and 46% vs. 34%, p=0.001, respectively), while serum triglyceride level were significantly lower in the ACh-positive group with MLP than those without (97 mg/dL vs. 123 mg/dL, p=0.036). Multiple logistic regression analysis identified female gender (OR: 1.867; 95%CI: 1.220-2.856; p=0.004), smoking (OR: 0.492; 95%CI: 0.323-0.750; p=0.001), and multivessel spasm (OR: 1.681; 95%CI: 1.185-2.383; p=0.004), as significant predictors of MLP in ACh-positive patients. During a mean follow-up period of 49±19 months, MACE was registered in 43 patients in ACh-positive patients. The proportions of current smokers, and patients with organic stenosis, focal spasm, variant angina, and high systolic blood pressure were significantly higher in the ACh-positive patients with MACE than those without. Multivariate Cox hazard analysis identified non-diffuse spasm subtype but not MLP as predictor of MACE. In conclusion, ACh-provoked MLP was frequently observed in non-smoking female VSA patients accompanied with multivessel coronary spasm, highlighting the usefulness of MLP measurements as a supporting diagnostic marker for ACh-provoked coronary spasm in those patients.
- © 2013 by American Heart Association, Inc.